Congestive heart failure: symptoms and treatment
When the human heart is not strong enough to maintain the proper level of blood circulation in the body, doctors diagnose the patient’s heart failure. It can be acute and chronic. The latter form of the disease is more common, and it is discussed in the article.
Chronic heart failure (CHF) is a pathological condition characterized by progressive loss of pump function of the heart. The main organ of the circulatory system begins worse to pump blood through the body, from which the arterial blood in sufficient quantity is not supplied to the tissues, and venous blood becomes stagnant. There are two option CHF:
- Left ventricle, which develops dysfunction of the left heart.
- Right heart, characterized by a dysfunction of the right ventricle.
As a rule, in people with advanced CHF there are signs of both types of pathology.
Common causes of CHF include:
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- Coronary heart disease (CHD).
- Arterial hypertension.
- Heart disease.
- Pathological changes of the aorta (they can be caused by atherosclerosis, diabetes, hypertension and other factors).
- Lung disease causing pulmonary hypertension (this is the main cause of isolated right ventricular CHF).
- Systemic autoimmune disease.
Mechanisms of development
CHF in contrast to the acute form of the disease develops gradually. That is, from the initial stages of cardiovascular or pulmonary disease before the occurrence of dysfunction of the heart may take 5 or 10 years (depending on compensatory abilities of the human body). However, in the future, if the underlying disease is left untreated, heart failure progresses faster already. The pathogenesis of CHF has a number of starting factors:
- The decrease in the contractility of the heart muscle due to chronic hypoxia, inflammation or degeneration.
- Overload myocardial pressure (occurs when the blood flow appear obstacles – a narrowed valve opening or vessels).
- The overload of heart by volume (develops heart defects, accompanied by backward reflux of blood).
Until the heart is ineffective, changes in the circulatory system, kompensiruet by increasing the volume of the myocardium (hypertrophy), enhanced and rapid heart rate. However, compensatory capabilities also runs out over time, the heart is «tired» and in his muscle there are various irreversible processes. All this leads to the fact that the pumping of blood through the circulatory system is disturbed.
If the patient affects the left heart, blood in low volume enters the aorta, tissues do not receive oxygen and nutrients. There is stagnation in the small circle of blood circulation (pulmonary vein oxygen-rich blood to flow into left atrium), which in turn entails the stretching and strain of the right ventricle.
In the case of joining of heart failure left ventricular dysfunction right heart develops stagnation in the systemic circulation, which causes edema, refilling of blood in the liver and pathological changes in the kidneys and other important organs.
Signs of heart failure
In chronic heart failure set and the severity of symptoms depends on patient’s stage of disease. Classification of American cardiologists, based on the tolerability of the patient load, assumes a 4 functional class CHF (for class 1 is characterized by the absence of any signs of illness during exercise in the 4th grade symptoms appear even in peace). In addition, cardiologists use a classification of Strazhesko-Athletic, in which there are 3 stages of CHF:
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- The first is the initial or latent dysfunction of the heart.
- The second, which is already showing signs of heart failure during physical activity. Then allocate 2 subclass: the subclass is characterized by the stagnation only to a small circle of blood circulation, the subclass is characterized by the emergence of signs of stagnation in the systemic circulation.
- The third is already irreversible stage of the disease, because the degenerative changes that occur in many organs at this stage, impossible to cure.
Some of the most common symptoms of CHF include the following:
- Shortness of breath.
- Heart palpitations.
- Swelling, which first appear on the feet.
- Bluish color of the skin on the hands and feet.
- Arching pain in the right upper quadrant (its occurrence is associated with the refilling of the hepatic blood vessels).
Principles of treatment of CHF
Treatment of CHF includes the following fields:
- The diet, which should prevent the stagnation of fluids in the body and reduce the weight of the patient.
- Physical activity that meets the functional status of the patient’s heart.
- Medical therapy. Use combinations of drugs of different groups: beta-blockers, diuretics, ACE inhibitors, peripheral vasodilators, if indicated – cardiac glycosides.
In addition, to avoid progression of heart failure it is necessary to treat the primary illness. If this is not possible, medications to maintain the heart patients must take for life.